| NPI | 1881050995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE M YOUTSOS Owner 620-308-6123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0438483) |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2020-12-10 |